Mapping Cold-Chain Waste in Immunization Programmes Across Waste Streams, Policy Coverage, and Operational Management

Background: Immunization programmes rely on cold-chain systems to protect vaccine quality, but these systems also generate waste streams that are not consistently addressed within conventional health-care waste frameworks. These include electronic temperature monitoring devices, data loggers, batteries, packaging materials, cooling accessories, damaged vaccine carriers, sensors, voltage stabilizers, obsolete parts, and decommissioned refrigerators and freezers. Methods: This review was conducted as a secondary evidence review with structured policy and guidance mapping. Peer-reviewed literature and guidance documents from global, technical, and national sources were reviewed to map cold-chain waste streams, assess policy and operational coverage, and identify relevant management pathways. Findings: Cold-chain waste is generated across vaccine shipment, storage, transport, outreach, maintenance, repair, replacement, and decommissioning. Existing guidance addresses some components, particularly obsolete refrigerators and freezers, but smaller items such as Q-tags, data loggers, batteries, sensors, packaging materials, ice packs, and broken accessories are covered indirectly, partially, or not as a unified programme-management issue. Relevant guidance is distributed across health-care waste management, e-waste regulation, procurement, asset management, vaccine logistics, and cold-chain equipment decommissioning documents. Interpretation: Cold-chain waste should not be treated as uniformly hazardous, but it should be recognized as a distinct operational category within immunization systems. A practical response requires risk-based classification, segregation, inventory, reuse or repair where appropriate, linkage with approved e-waste and disposal systems, stronger procurement clauses, and integration into EVM assessments, continuous improvement plans, vaccine-store SOPs, and national logistics working group processes. A concise global reference framework could help countries manage cold-chain waste through existing health, environmental, procurement, and asset-management systems.